FORMS & RESOURCES
PATIENT REGISTRATION FORMS
Please complete these forms and bring them to your first appointment.
RELEASE OF PRIVATE HEALTH INFORMATION
Please complete this form if you wish to change how your personal information is disclosed.
AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION
The form must be completed by the patient when they would like a copy of their medical records provided to them or another healthcare provider. This form must also be completed by the patient when giving the Falcon Health Center permission to disclose personal health information for reasons other than treatment, payment or health care operations. There may be a charge for copies.
AUTHORIZATION TO COMMUNICATE BY EMAIL
In recognition of the fact that email is the preferred form of communication for many patients and staff, email between patients and staff is permitted within procedural guidelines intended to provide confidentiality and security to the fullest extent possible. The Authorization to Communicate by Email form must be completed, signed and returned to the Falcon Health Center prior to email communication.
VERIFICATION OF MEDICATION ORDERS
This form must be completed by a physician for those requiring administration of medication. In addition to a prescription sent to the pharmacy, our physicians will need a doctor’s order from the prescribing physician with information about the last administration. This information can be faxed to our office at 419.354.3222.
HIGH SCHOOL PHYSICAL CLINIC FORMS
Please print and complete the following forms and bring to the high school physical clinic. These forms are necessary for the physical to be completed. We will be unable to see any patients that do not have completed forms.
Falcon Health Center is located next to the Bowling Green State University (BGSU) campus.
The Center serves the entire surrounding community as well as the BGSU faculty, staff and students. Falcon Health Center offers convenience care appointments with medical providers, immunizations, travel medicine, skin screenings, lab and radiology services, acupuncture, chiropractic care and physical therapy. For your convenience the Falcon Health Center offers a full-service pharmacy with drive through.